This proposal requests continued support for the Medical Scientist Training Program (MSTP) at Vanderbilt University School of Medicine. The primary goal of the Vanderbilt MSTP is to identify, mentor, and foster the careers of future leaders in academic medicine who are dedicated to improving human health through discovery. The program is based on rigorous training in clinical medicine and scientific inquiry. Successful completion of the MSTP leads to both M.D. and Ph.D. degrees. Core elements of the program developed specifically for dual-degree students include a foundational course in research, literature-based seminar series, clinical preceptorship program, data club, leadership workshop, career development workshop, physician-scientist speaker series, and an annual retreat. Formal instruction in the responsible conduct of research is provided throughout the curriculum. MSTP students are assigned to one of four innovative advising colleges that provide a framework for academic counseling by faculty and peers. Current students play key roles in new student recruitment, program administration, and curriculum development. Seventy-two percent of our graduates with established careers hold academic or private-sector research positions, including two deans, four department chairs, and 24 full professors. More recent graduates have been placed in superb residencies and fellowships. The 92 current trainees come from 57 colleges and universities distributed across North America. The nationwide applicant pool results from concerted recruiting efforts, including those focused on the recruitment of students from groups underrepresented in medicine. In the current year, 380 applications have been received, from which 12 students will be selected to enter the incoming class. The proposed goal is to increase the size of the program to a steady state of 112 students over the next five years. Extramural research funding at Vanderbilt has increased from $389 million to $444 million since 2008. Research opportunities for MSTP trainees include established strengths in biomedical informatics, cancer biology, cell biology, clinical pharmacology, diabetes, neurosciences, toxicology, and vaccine science as well as new areas of emphasis in chemical and physical biology, drug discovery, genetics, imaging sciences, microbial pathogenesis, pharmacogenomics, and structural biology. As such, the educational environment for physician- scientists at Vanderbilt is outstanding. The proposal requests an increase in funded positions to 24 for the five- year project period. Ongoing support for the Vanderbilt MSTP is justified based on the strength of the applicant pool, numerous opportunities for physician-scientist training, an institutional commitment to the education of leaders in biomedical research, and success of our graduates in academic medicine.